Since the shoulder is a ball and socket, the ball can shift out of the socket (dislocate). WebMOTIONS TO AVOID: Do not lift shoulder out in front of body, out to your side, or reach behind your back until your physical therapist has progressed you to that point in therapy. Other treatment options including medications, injections, physical therapy, or other types of surgery will also be discussed and considered. The surgical procedures can range from a simple smoothing of the roughened bone to a resurfacing of the humeral head with a smooth prosthesis such as a cuff tear arthropathy (CTA) head fixed to the shaft of the arm bone (humerus). Moderate to severe pain while resting. Some of these may need to be modified or stopped. Walk your hand slowly up the wall with your fingers. Wear the sling as you are told to by your doctor to limit movement of your shoulder. You have prior arthroscopic surgery, rotator cuff or fracture repair that failed to relieve your symptoms. Also, refrain from using your arm to lift, reach, push or pull above waist level (for six weeks). Your doctor and physical therapist will let you know when it is safe to return to all standard movements. Older patients with osteoporosis are most at risk for severe shoulder fractures. The staples will be removed several weeks after surgery. Over the years, shoulder joint replacement has come to be used for many other painful conditions of the shoulder, such as different forms of arthritis. Studies show that patients with osteoarthritis get better pain relief from total shoulder arthroplasty than from hemiarthroplasty. The surgeon's office should provide a reasonable estimate of the surgeon's fee and the hospital fee. All rights reserved. Failed conventional shoulder joint replacements and failed fracture surgery may also be treatable using a reverse total shoulder replacement. It lessens a persons pain in more than 90 out of 100 cases. Cleveland Clinic is a non-profit academic medical center. (https://pubmed.ncbi.nlm.nih.gov/25213827/), (https://orthoinfo.aaos.org/en/treatment/shoulder-joint-replacement/). Instead of mistakenly Over time, the shoulder joint slowly becomes stiff and painful. Weight lifting advice for patients that have had shoulder Some individuals need surprisingly little pain medication after this procedure. If there is an infection, prosthesis would not be inserted, but rather, the shoulder would require surgical cleaning out and extensive postoperative antibiotics. They may be either cemented or press fit into the bone. But if a patient has the additional problem of an ineffective rotator cuff, this will not be solved by simply replacing the diseased parts of the shoulder joint. Certain surgeons specialize in rotator cuff tear arthropathy (arthritis of the shoulder associated with a massive cuff tear). Start eating normal meals as soon as you feel like you can. 8). Continue exercises at home as instructed by your physical therapist and other healthcare providers. But the manufactured implants for a reverse shoulder are a constrained design. Patients with diabetes may get wound complications and infections. Pacific St. You may continue to bandage the wound to prevent irritation from clothing. Wound care. The rotator cuff also gives the shoulder joint its wide range of motion. They are usually changed the second day after surgery. infection (which can be sufficiently serious to require revision surgery, including removal of the prosthesis). This is called a stemmed hemiarthroplasty. These medications may cause drowsiness and a dry mouth. For the first month or so after this procedure the operated arm may be less useful than it was immediately beforehand. Usually the individual is asked to lift nothing heavier than a cup of coffee for six weeks after the surgery. General instructions include the following: Your rehabilitation will be ongoing and progressive. It is rare for your doctor to order therapy before your first follow-up visit. The treatment options are either replacement of just the head of the humerus bone (ball), or replacement of both the ball and the socket (glenoid). The most important test for cuff tear arthropathy is the x-ray characteristically showing rounding off of the humeral head as it contacts with the undersurface of the coracoacromial arch. Thus, prevention of falls is very important. Reverse shoulder replacements have a high success rate, and most patients can resume a normal lifestyle with full function within months afterward. After Reverse You will also be given a choice to supplement your anesthesia with a regional or block anesthetic to minimize your postoperative pain. Hydrocodone or Tylenol with codeine are taken by mouth. With its bone-preserving advantage, it offers those with arthritis of the shoulder an alternative to the standard stemmed shoulder replacement. In later stages of rotator cuff tear arthropathy, the humeral head migrates upwards but is stabilized by the overlying coracoacromial arch in spite of the lack of rotator cuff (See Fig. The operating room will be bright and very cool. Using special techniques and a reversed total shoulder design (See Fig. Wear loose-fitting clothes and a button-front shirt when you go to the hospital for your surgery. Blankets are available to keep you warm. An occupational therapist will visit you at least once in the hospital before you are discharged. Reverse shoulder replacement can be done either in-patient or outpatient, depending on your surgeon and your individual needs. After surgery, most patients are able to eat a regular dinner and walk to the bathroom. Youll likely be advised not to move your shoulder for at least a few days. The most common reasons for a shoulder replacement surgery are osteoarthritis, rotator cuff tear arthropathy, avascular necrosis or rheumatoid arthritis. Potential complications of shoulder replacement surgery include: Dislocation. If the exercises are uncomfortable difficult or painful the individual should contact the surgeon promptly. The Reasons for Reverse Shoulder Replacement Surgery - Verywell After you wake up, you will be taken to your hospital room. In the absence of home support a convalescent facility may provide a safe environment for recovery. The bones then rub against one another. Because shoulder surgery is painful, pain control is very important. Most people are better able to raise their arm over their head. the individual is sufficiently healthy to undergo the procedure. 10). In the two videos below, Dr. Frederick Matsen, UW Medical Center orthopedic surgeon, discusses a new and innovative shoulder replacement surgery featuring a reverse ball/socket technique that can lessen pain and improve function in shoulders with failed surgery or combined arthritis, rotator cuff tears and instability issues. Please note that any healthcare provider or dentist contemplating a future operative or invasive procedure, including dental work, must give you antibiotics preoperatively and postoperatively to prevent infection. Early overuse of the shoulder may result in severe limitations in motion. The bone around the replacement joint could be damaged during the procedure. They will monitor your vital signs (blood pressure, pulse and breathing) frequently while you are recovering from the effects of anesthesia. Good pain control is an important part of the postoperative management. Limited use after total shoulder replacement with a reversed prosthesis is critical for protection during the early phases of healing. For instance, it generally takes less time to get cleared to return to an office job than a highly physical job. For instance, your doctor will tell you when it is safe to drive, return to work, or take on other daily activities. Pre-operative planning for reverse shoulder replacement: The surgical benefits and their clinical translation. Pain medications can cause drowsiness, slowness of breathing, difficulties in emptying the bladder and bowel, nausea, vomiting, and allergic reactions. Some of the risks of shoulder replacement surgery with a reversed prosthesis can be effectively managed if they are promptly identified and treated. WebComplications from anatomic total shoulder arthroplasty (TSA) are approximately 10% and include hardware loosening, glenoid wear, instability, and rotator cuff tear. Dont do any repetitive heavy lifting. If nonsurgical treatments like medications and activity changes are no longer helpful for relieving pain, you may want to consider shoulder joint replacement surgery. Patients considering reverse shoulder surgery have often run out of other options for restoring function to their damaged shoulder. Edward McFarland explains a reverse total shoulder replacement as a complex procedure that is warranted by certain conditions. WebWhat are the limitations after reverse shoulder replacement? For some individuals, balancing the benefit and the side effects of pain medication is challenging. Stand with your palms on the wall in front of you. A series of pre-operative tests will be scheduled one to two weeks before surgery. For more information:Glenohumeral Joint Osteoarthritis - Clinical Practice Guideline (CPG) | American Academy of Orthopaedic Surgeons (aaos.org). The physical exam will help the surgeon determine the source of pain and also the decrease in range of motion. When you come home from the hospital, you will need help for a few weeks with some daily tasks like dressing, bathing, cooking, and laundry. 13). You will need to keep doing this for 6 to 8 weeks after your surgery, even when wearing a sling. Sterile surgical draping will be hung to shield and protect the surgical site. An artificial ball implant is attached to the scapula where the glenoid socket used to be, and an artificial socket is attached to the top of the humerus where the natural ball used to be. Its recommended that you arrange for someone to drive you and help you get safely. Your surgeon will evaluate your situation carefully before making any decisions. 1 and 2), qualified surgeons can improve the stability of the shoulder and enable the deltoid muscle to power it, even in the absence of a normal rotator cuff. The surgery itself may interfere with your sleep-wake cycle. Second, you should ask you doctor if you have any restrictions or recommended limitations. This should be worn for the first four weeks. Reverse shoulder replacement surgery is highly successful as a pain-relieving procedure. The risks of this surgery include but are not limited to the following: Any of these problems may result in major loss of function to the arm. Contact Us, University of Washington This procedure does not restore the ability of the shoulder to perform heavy work or sport. Your shoulder is an important joint that rotates with a greater range of motion than any other joint in your body. Reverse shoulder replacement is an option for people with severe shoulder pain who have shoulder arthritis and rotator cuff damage. Painful shoulder conditions, such as shoulder arthritis and rotator cuff tears, are common. Sometimes complete removal of the prosthesis is necessary. Before surgery, reverse-candidate patients often have poor shoulder function, pain during everyday activities and are often up at night from shoulder pain. Your dressing will be removed at your first follow up appointment. (Right)The reverse total shoulder replacement allows other muscles such as the deltoid to do the work of the damaged rotator cuff tendons. Most people who have reverse shoulder replacement surgery do see an improved range of motion. Your family will not be permitted in the PACU, but may visit when you are assigned to a hospital room. Hansen ML, et al. If the symptoms of rotator cuff tear arthropathy (shoulder arthritis with a massive rotator cuff tear) are mild the condition may be treated with gentle motion exercises. Your surgeon and physical therapist will help you during rehab and recovery. Do ask for assistance. WebDislocation: In case of reverse total shoulder replacement, implant may dislocate which requires closed reduction or surgery to reduce or revise the implant. Younger patients may be more disappointed with the mechanical limitations of their new shoulder. The ball joint is attached to the shoulder bone, and the socket is attached to the upper arm bone.